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ATLAS OF TUMOR PATHOLOGY

Third Series
Fascicle 7

TUMORS OF THE
MAMMARY GLAND

by

PAUL PETER ROSEN, M.D.
Attending Pathologist and Member
Memorial Sloan-Kettering Cancer Center
1275 York Avenue, New York, New York 10021
Professor of Pathology
Cornell University Medical College

and

HAROLD A. OBERMAN, M.D.
Professor of Pathology
University of Michigan School of Medicine
1500 East Medical Center Drive
Ann Arbor, Michigan 48109

Published by the
ARMED FORCES INSTITUTE OF PATHOLOGY
Washington, D.C.

Under the Auspices of
UNIVERSITIES ASSOCIATED
FOR RESEARCH AND EDUCATION
IN PATHOLOGY, INC.
Bethesda, Maryland
1993

Accepted for Publication
1992

Available from the American Registry of Pathology
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000
ISSN 0160-6344
ISBN 1-881041-07-7

ATLAS OF TUMOR PATHOLOGY

EDITOR
JUAN ROSAI, M.D.
Department of Pathology
Memorial Sloan-Kettering Cancer Center
New York, New York 10021-6007

ASSOCIATE EDITOR
LESLIE H. SOBIN, M.D.
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000


EDITORIAL ADVISORY BOARD


Jeffrey Cossman, M.D.
Georgetown University School of Medicine
Washington, D.C. 20007

Ronald A. DeLellis, M.D.
Tufts University School of Medicine
Boston, Massachusetts 02111

Glauco Frizzera, M.D.
Armed Forces Institute of Pathology
Washington, D.C. 20306-6000

Leonard B. Kahn, M.D.
Long Island Jewish Hospital
New Hyde Park, New York 11042

Richard L. Kempson, M.D.
Stanford University Medical School
Stanford, California 94305

Paul Peter Rosen, M.D.
Memorial Sloan-Kettering Cancer Center
New York, New York 10021

Robert E. Scully, M.D.
Harvard Medical School and
Massachusetts General Hospital
Boston, Massachusetts 02114

Steven G. Silverberg, M.D.
The George Washington University
School of Medicine
Washington, D.C. 20037

Sharon Weiss, M.D.
University of Michigan School of Medicine
Ann Arbor, Michigan 48109-0602


EDITORS' NOTE

The Atlas of Tumor Pathology has a long and distinguished history. It was
first conceived at a Cancer Research Meeting held in St. Louis in September
1947 as an attempt to standardize the nomenclature of neoplastic diseases.
The first series was sponsored by the National Academy of Sciences-National
Research Council. The organization of this Sisyphean effort was entrusted to
the Subcommittee on Oncology of the Committee on Pathology, and Dr. Arthur
Purdy Stout was the first editor-in-chief. Many of the illustrations were
provided by the Medical Illustration Service of the Armed Forces Institute of
Pathology, the type was set by the Government Printing Office, and the final
printing was done at the Armed Forces Institute of Pathology (hence the
colloquial appellation "AFIP Fascicles"). The American Registry of Pathology
purchased the Fascicles from the Government Printing Office and sold them
virtually at cost. Over a period of 20 years, approximately 15,000 copies
each of nearly 40 Fascicles were produced. The worldwide impact that these
publications have had over the years has largely surpassed the original goal.
They quickly became among the most influential publications on tumor
pathology ever written, primarily because of their overall high quality but
also because their low cost made them easily accessible to pathologists and
other students of oncology the world over.

Upon completion of the first series, the National Academy of Sciences-
National Research Council handed further pursuit of the project over to the
newly created Universities Associated for Research and Education in Pathology
(UAREP). A second series was started, generously supported by grants from the
AFIP, the National Cancer Institute, and the American Cancer Society. Dr.
Harlan I. Firminger became the editor-in-chief and was succeeded by Dr.
William H. Hartmann. The second series Fascicles were produced as bound
volumes instead of loose leaflets. They featured a more comprehensive
coverage of the subjects, to the extent that the Fascicles could no longer be
regarded as "atlases" but rather as monographs describing and illustrating in
detail the tumors and tumor-like conditions of the various organs and
systems.

Once the second series was completed, with a success that matched that of the
first, UAREP and AFIP decided to embark on a third series. A new editor-in-
chief and an associate editor were selected, and a distinguished editorial
board was appointed. The mandate for the third series remains the same as for
the previous ones, i.e., to oversee the production of an eminently practical
publication with surgical pathologists as its primary audience, but also
aimed at other workers in oncology. The main purposes of this series are to
promote a consistent, unified, and biologically sound nomenclature; to guide
the surgical pathologist in the diagnosis of the various tumors and tumor-
like lesions; and to provide relevant histogenetic, pathogenetic, and
clinicopathologic information on these entities. Just as the second series
included data obtained from ultrastructural (and, in the more recent
Fascicles, immunohistochemical) examination, the third series will, in
addition, incorporate pertinent information obtained with the newer molecular
biology techniques. As in the past, a continuous attempt will be made to
correlate, whenever possible, the nomenclature used in the Fascicles with
that proposed by the World Health Organization's International Histological
Classification of Tumors. The format of the third series has been changed in
order to incorporate additional items and to ensure a consistency of style
throughout. This includes the dropping of the 's possessive in eponymic
terms, in accordance with the WHO and the International Nomenclature of
Diseases. Close cooperation between the various authors and their respective
liaisons from the editorial board will be emphasized to minimize unnecessary
repetition and discrepancies in the text and illustrations.

To its everlasting credit, the participation and commitment of the AFIP to
this venture is even more substantial and encompassing than in previous
series. It now extends to virtually all scientific, technical, and financial
aspects of the production.

The task confronting the organizations and individuals involved in the third
series is even more daunting than in the preceding efforts because of the
ever-increasing complexity of the matter at hand. It is hoped that this
combined effort — of which, needless to say, that represented by the authors
is first and foremost — will result in a series worthy of its two illustrious
predecessors and will be a suitable introduction to the tumor pathology of
the twenty-first century.


Juan Rosai, M.D.
Leslie H. Sobin, M.D.


ACKNOWLEDGMENTS

The authors are responsible for the content of this book but it could not have
been prepared without the support and assistance of many individuals. We wish
to acknowledge the innumerable patients from whom we have learned about the
diseases described in this volume. Many pathology residents, fellows, and
faculty associates at Memorial Hospital and at the University of Michigan
invested a great deal of time and effort working up specimens that provided
some of the material selected for photography. Other illustrations were
obtained from cases submitted for diagnostic consultation over several decades
by a large number of pathologists. We are especially grateful to these
colleagues for their continued support, encouragement, and interest in seeking
a better understanding of clinical and pathologic aspects of breast disease.
The goal of these efforts is the optimal diagnosis and treatment of breast
disease and, ultimately, the development of measures for its prevention. We
also wish to acknowledge a number of individuals who made important and direct
contributions to the preparation of this Fascicle. Ellen Cohen and Milicent
Cranor, of Memorial Sloan-Kettering Cancer Center, and Ann Miller, of the
University of Michigan, were responsible for typing and editing as well as for
bibliographic work. Kin Kong, chief photographer, and Lisa Hollis, assistant
photographer, of Memorial Sloan-Kettering Cancer Center, and Craig Biddle and
Mark Deming, photographers in the Department of Pathology of the University of
Michigan, developed and printed outstanding photographs from which a modest
number were selected for use in this book. Electron photomicrographs were
generously supplied by Dr. Robert A. Erlandson, of Memorial Sloan-Kettering
Cancer Center.

We also wish to acknowledge the following individuals who provided case
material specifically for inclusion in this Fascicle: Dr. Ron Neafie, of the
Armed Forces Institute of Pathology, Dr. Juan Rosai, of Memorial
Sloan-Kettering Cancer Center, Dr. Jeffrey Searle, of the Royal Brisbane
Hospital in Brisbane, Australia, and Dr. Sami Shousha, of the Charing Cross
Hospital in London, U.K.

Dr. Frances Pitlick, Beverly Lea, Dian Thomas, Paul Clifford, and Audrey Kahn
of the UAREP were extremely helpful during the preparation of the manuscript
and production of this book. We also appreciate the helpful comments of the
Editor-in-Chief and of the Editorial Advisory Board of the Third Series of the
Fascicles, and we are particularly grateful to the anonymous reviewers of the
initial draft of the book for many constructive suggestions.

The patient support and assistance of Dr. Carolyn Mies and Dr. Marylen
Oberman were crucial to the preparation and completion of this volume.


Paul Peter Rosen, M.D.
Harold A. Oberman, M.D.


Permission to use copyrighted illustrations has been granted by:


American Medical Association:
Arch Pathol Lab Med 115:141-5, 1991. For figure
377.

American Society of Clinical Pathologists:
Tumors of the Breast. Proceedings of the 53rd
Annual Anatomic Pathology Slide Seminar of
the American Society of Clinical Pathologists,
1987. For figures 258, 417, 506, 516, 526, and 530.

Appleton & Lange:
Pathol Annu 18(Pt 2):215-32, 1983. For figures 251
and 252.
Pathol Annu 19(Pt 1):195-219, 1984. For figures
345-7.
Pathol Annu 24(Pt 2):237-54, 1989. For figures 370
and 372.

JB Lippincott Company:
Am J Clin Pathol 94:371-7, 1990. For figure 393.
Ann Surg 204:612-3, 1986. For figures 592 and 593.
Breast Diseases. 2nd ed. 1991. For figures 245, 246,
248, 268, 280-2, 295, 310, 342, 343, 351, 356, 369,
375, 385, and 583.
Cancer 59:1927-30, 1987. For figures 127 and 129.
Cancer 61:1611-20, 1988. For figure 392.
Cancer 63:1363-9, 1989. For figure 490.

Raven Press:
Am J Surg Pathol 2:225-51, 1978. For figure 187.
Am J Surg Pathol 4:241-6, 1980. For figures 203
and 204.
Am J Surg Pathol 5:629-42, 1981. For figures 505,
507, 508, and 520.
Am J Surg Pathol 7:739-45, 1983. For figures 122-5.
Am J Surg Pathol 8:31-41, 1984. For figure 380.
Am J Surg Pathol 8:907-15, 1984. For figures 562,
566, and 567.
Am J Surg Pathol 9:491-503, 1985. For figures 456
and 463.
Am J Surg Pathol 9:659-65, 1985. For figures 471-4.
Am J Surg Pathol 9:723-9, 1985. For figures 476
and 477.
Am J Surg Pathol 10:87-101, 1986. For figures 101-3,
108, 113, 116, 118, 119, and 121.
Am J Surg Pathol 10:464-9, 1986. For figures 296
and 297.
Am J Surg Pathol 11:351-8, 1987. For figure 329.
Am J Surg Pathol 14:12-23, 1990. For figure 260.

WB Saunders Company:
Hum Pathol 17:185-91, 1986. For figures 480-3.
Hum Pathol 18:1232-7, 1987. For figures 133, 135,
142, and 143.

Williams & Wilkins Company:
Mod Pathol 1:98-103, 1988. For figures 501 and 503.

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